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October 25, 2001

Group Health researchers explore the cost of better depression care

Seattle—Researchers at Group Health Center for Health Studies recently found that providing better-organized treatment for depressed patients resulted in significantly better outcomes while moderately increasing the cost of care. Over a six-month period, patients at Group Health who received an enhanced treatment program experienced, on average, about 16 more depression-free days than people who got standard care.

Funded by the National Institute of Mental Health (NIMH), the study was published in the October 2001 issue of the American Journal of Psychiatry.

The enhanced program included alternating visits by a psychiatrist and the patient's primary-care doctor, systematic monitoring of follow-up visits and medication, and an educational book and videotape.

The researchers' findings are consistent with several recent depression-care studies conducted at Group Health and elsewhere. This study differed, however, in that it focused on patients most in need of extra services—those who got prescriptions for antidepressants from their primary care doctors, but were not doing well after six to eight weeks.

"Health care organizations that want to do more for depressed patients, but are concerned about cost, might choose an approach like this," says Greg Simon, MD, MPH, investigator at the Center and the study's principal investigator. "They might not be able to provide enhanced treatment for every depressed patient, but perhaps they could provide it for a subset of patients who would be most likely to benefit from it."

This point was reinforced in an editorial in the October 27 issue of the British Medical Journal by Michael Von Korff, ScD, a Center for Health Studies senior investigator who also worked on the study. Citing evidence from several depression–care studies, Von Korff writes, "Efforts to improve the primary care of major depression should focus on low–cost case management coupled with a fluid and accessible working relationship among the primary care doctor, the case manager, and a mental health specialist."

The enhancements in Simon and Von Korff's study cost an additional $357 per patient—or about $21.44 per depression–free day. These increased costs are comparable to amounts spent to improve care for other important health problems such as heart disease or cancer, Simon explains.

"Depression is like most other important health conditions," he adds. "If you spend more money and improve the quality of care, you have better outcomes."

This study, like previous mental–health research at Group Health, will help the Cooperative's Depression Road Map Team to select the most effective and efficient approaches to treating all Group Health members who need depression care.

Group Health Center for Health Studies conducts epidemiologic, health–services, and clinical research related to prevention, diagnosis, and treatment of major health problems. The Center also evaluates the efficacy and cost–effectiveness of health care services and technologies. Funded primarily through government and private research grants, the Center is located in Seattle, Washington.

Group Health Cooperative is the nation's largest consumer–governed health care system, serving nearly 600,000 people in Washington and Idaho.

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